Pathophysiology Exam #3 Flashcards Preview

Question 1

1

How many total vertebra are in the spinal column?

33

Answer

plural, vertebra is singular

Answer

There are 4 curvatures(from an anterior perspective)
1. cervical convexity-curved towards the ANTERIOR part of the body
2. thoracic concavity-curved towards the POSTERIOR part of the body
3. lumbar convexity-curved towards the ANTERIOR part of the body
4. sacral concavity-curved towards the POSTERIOR part of the body

Answer

BODY: weight bearing and protection of spinal cord
o Largest and the thickest part of the SCol
o In between sits the intervertebral disk
§ separates and cushions
§ integrity is important for the disk,
§ keeps the intervertebral foramen the same size

Answer

(1) Two pedicles, attached to body
(2) Two laminae, joins lamina from opposite half of
arch
§ lamina from one side and the lamina from the
other, form the SPINOUS PROCESS

Answer

o Extends laterally from each side of arch between
lamina and pedicle
o Attachment for skeletal muscles

Answer

o Junction between TWO lamina
o Attachment for skeletal muscles
o Sometimes curved down, sometimes they’re
horizontal
o What you are palpating down the spine

Answer

foramina of all vertebrae;It forms the vertebral canal for the entire spinal cord
• This is where the SCord sits
• The vertebral foramen size is different, in
different segments of the vertebral columns
because the SCord is not the same diameter all the
way down

Answer

o Exit for spinal nerves and blood vessels
o Formed by superior and inferior intervertebral
notches in pedicles of adjacent vertebrae
o INFERIOR and SUPERIOR INTERVERTEBRAL NOTCH
§ WHERE THE SPINAL NERVE ROOTS EXIT
o DO NOT CONFUSE VERTEBRAL FORAMEN WITH INTERVERTEBRAL FORAMEN

Answer

Foot of the arch with one on each side; forms the lateral wall of the vertebral foramen

Answer

Posterior part of the vertebral arch; forms the posterior wall of the vertebral foramen

Answer

Superior and inferior projections containing articular facets where vertebrae articulate with each other; strengthen the vertebral column and allow for movement.

Answer

§ ATLAS (C1):
- no body
-no spinous process
-large superior articular facets for base of skull (occipital
condyles) to sit
-large vertebral foramen
v supports the skull
v facet is where the DENS sits
v allows the head and neck to move up and down (to nod)

Answer

§ AXIS (C2): dens that fits into vertebral foramen of atlas
v DENS (projection upwards) aka the ODONTOID PROCESS
Ø allows for the rotation of the neck
§ Superior articular facet on C2 sits into the inferior articular facet of C1

Answer

o Bifid spinous processes
§ bifid: split at the end of the spinous processes
§ muscles of the neck connect here
§ most cervical vertebrae are bifid, for muscle attachment

Answer

• CERVICAL(7 vertebrae)
o Small bodies
o Bifid spinous processes
o Horizontal spinous processes
o Transverse foramina (located in the transverse processes) for vertebral arteries(except C7)
§ very important: the cervical transverse foramina have
vertebral arteries that pass through the foramen magnum
that supply the base of the brain
o Relatively large vertebral foramina for cervical
enlargement of spinal cord

Answer

C7 (VERTEBRA PROMINENS); usually (but not always) has no transverse foramina
*sometimes associated with an extra "cervical rib"

Answer

• THORACIC VERTEBRAE(12 vertebrae)
o Long, thin spinous processes, which become more vertical from above downward
o Vertebral foramina smaller than in cervical vertebrae
o Bodies larger than cervical vertebrae and increase in size from above downward
§ more weight bearing
o Only the first 10 (thoracic vertebrae) have costal facets on transverse processes and bodies for articulations with rib heads and tubercles
§ Superior articular facet for rib head
§ Inferior articular facet for rib head
§ Articular facet for tubercle of rib
o Does not have any transverse foramina in the transverse processes (not arteries)
o Spinous processes are no longer bifid and are fairly
vertical
o Vertebral foramen smaller
o Superior articular facet articulates with the inferior
articular facet above that
o Inferior intervertebral notch: where nerve roots exit

Answer

• THORACIC VERTEBRAE AND RIB ARTICULATIONS
o 12 ribs in man and woman
o 1st seven ribs are called TRUE
RIBS
§ posteriorly they articulate with the vertebral column
§ continue out posteriorly then laterally
§ then curve anteriorly
§ joined with cartilage SEPARATELY, that then joins
to the body of the sternum
o Rib #1 articulates with the manubrium
o Rib #2 joins at the sternal angle
o Ribs #3-7 articulate with the sternum
o Ribs 8-12 are called the FALSE RIBS
§ each rib does not directly join to cartilage that attaches to sternum
§ cartilage to cartilage
o Ribs 11-12 do not join at all and are called the FLOATING RIBS

Answer

o Sternal angle (significance): to properly find the proper correct anatomical landmarks for assessing heart
sounds(T2)

Answer

• LUMBAR VERTEBRAE(5 vertebrae)
o large, thick vertebral bodies
o heavy transverse and spinous processes for HEAVY WEIGHT BEARING and limited rotation;
o no transverse foramina and no costal facets;
o almost horizontal spinous processes

Answer

• SACRAL VERTEBRAE
o 5 vertebrae fused to form sacrum
§ no disk between the vertebral bodies
o Intervertebral foramina: Dorsal and ventral foramina
(where nerve roots exit)
o Anterior edge of body of first sacral vertebra bulges to
form sacral promontory
o 1st sacral vertebra is called the SACRAL PROMONTORY
( that was used to measure the diameter of the birth canal -unknown if this is stilled used)
o SACRAL HIATUS (posterior): used for caudal blocks

Answer

• COCCYX à
o 3-5 (average 4) fused bones; no vertebral foramina or transverse processes
o the opening or junction between the sacrum and coccyx is where the coccygeal spinal nerve exits

Answer

Provides cushion
Adds length to SC in the adult

• Fibrocartilaginous structures between adjacent vertebral bodies from AXIS TO SACRUM; prevent vertebrae from rubbing against each other
• There is not a disk between the skull and C1; or
between C1 and C2; no disk in the sacral either
• 25% of length of adult vertebral column; thickest in
lumbar region

Answer

o ANULUS FIBROSUS (can be spelled with one or
two N’s): outer concentric fibrous tissue
o NUCLEUS PULPOSUS: central, springy, pulpy
zone(§ provides cushioning between vertebral bodies
and adds a significant percentage to the length of the vertebral column

WITH AGE THE DISC LOOSE WATER AND COLLAGEN CAUSING SHRINKAGE AND DECREASE IN ABILITY OF MOVEMENT(or painful movements)

Answer

• Its important that the intervertebral disks remain at a
consistent size because of the intervertebral foramen; so
the opening will remain the same size
o if the intervertebral disk loses volume/ water, becomes dehydrated, that area will be narrowed,
o placing pressure on the sensory nerves that enter
and motor nerves that exit.
o Which can cause problems in the periphery, in terms
of sensations; loss of sensations/ painful sensations
o Can also cause alterations in motor movement

Answer

o Many people have herniated disks
o As I mentioned the outer part is the annulus fibrosis.
o The center is the nucleus pulposus; a pulpy area
§ Sometimes the integrity of the annulus fibrosus is lost, allowing the nucleus pulposus to herniate.
§ It usually herniates POSTERIORLY
§ It compresses the intervertebral foramen, compressing that nerve root that exits there
§ Loss of sensations, loss of muscle activity, painful sensations, etc.; to the various parts of the body that is innervated
o Repair:
§ old approach: laminectomy
§ modern approach: use of a cushioned disk to supplement that area

Answer

• ANTERIOR LONGITUDINAL
LIGAMENT:
o extends from ANTERIORLY tubercle of ATLAS TO SACRUM;
o increases in width from above downward;
o CONNECTS THE ANTERIOR VERTEBRAL BODIES AND
INTERVERTEBRAL DISKS

Answer

o extends from AXIS TO SACRUM
o CONNECTS THE POSTERIOR VERTEBRAL BODIES AND INTERVERTEBRAL DISKS

o broader above than below;
o lies within vertebral canal behind vertebral bodies

Answer

• LIGAMENTA FLAVA:
o JOIN ADJACENT LAMINAE;
o small gap in midline between right and left
ligamentum flavum for passage (exit) of (small) veins
o LIGAMENTUM FLAVUM = SINGULAR (talking
about either the one on the L or the R);
LIGAMENTA FLAVA = PLURAL (talking about
both) SPELLING IS IMPORTANT!!!

Answer

• SUPRASPINAL LIGAMENTS:
o INTERCONNECT TIPS OF SPINOUS PROCESSES
FROM 7TH CERVICAL VERTEBRA TO SACRUM;
o continuous with ligamentum nuchae above and
interspinal ligaments in front;
o increase in thickness from above down

Answer

• INTERSPINAL LIGAMENTS:
o EXTEND BETWEEN ROOTS AND APEXES OF
SPINOUS PROCESSES;
o best developed in lumbar region

Answer

• INTERTRANSVERSE LIGAMENTS:
o ADJOIN ADJACENT TRANSVERSE PROCESSES
o Run the length of the Spinal Column

Answer

foramen magnum

Answer

SPINAL CORD
• Continuation of medulla oblongata; foramen magnum divides spinal cord from medulla oblongata
• About 46 cm long
• Extends from foramen magnum/atlas to where it terminates at the conus medullaris at vertebrae
L1 – L2

Answer

cervical enlargement
lumbosacral enlargement

• The diameter of the SCord is not the same all the way down
• There is an ENLARGEMENT IN THE CERVICAL AREA because that is the ORIGIN OF THE NERVES THAT INNERVATE THE ARMS, HANDS AND FINGERS
• There is also an ENLARGEMENT OF the SCord in the LUMBAR SEGMENT because that is the ORIGIN OF NERVES THAT INNERVATE THE HIPS, LEGS, FEET, AND TOES

Answer

conus medullaris

Answer

From conus medullaris, there’s a ligament called the FILUM TERMINALE that extends to coccyx and anchors spinal cord to coccyx

Answer

• The various segments of the SCord are named according to the vertebrae beside which they originated during fetal development.
• In adulthood, those SCord segments no longer lie adjacent to those vertebrae, but they still carry the same names as they always did.

*spinal cord segments move up in relation to the spinal column*

Answer

Cauda equina(horses tail)

Answer

above C1 and below the skull

Answer

v BRACHIAL PLEXUS: from ventral rami of C5,
C6, C7, C8, T1 (with contributions from C4 and T2)

Answer

1. nerve cell bodies
2. and their dendrites

axons synapse with those dendrites

Answer

1. Dorsal(posterior) horn
2. Ventral(anterior) horn

Answer

lateral horns(primarily T1-L2 and the sacral segments of the SC) sympathetic and parasympathetic

Answer

gray commissure

Answer

the 4th ventricle

Answer

Bundles of axons and their myelin sheaths or we could say consist of tracts that ascend and descend

Answer

posterior median sulcus

Answer

anterior median fissure

Answer

fissure is a fairly wide and deep separation, whereas a sulcus is not as wide or deep although it still separates

Answer

No just an anterior white commissure

Answer

The anterior spinal artery

Answer

white matter

Answer

peripheral, spinal cord, dorsal root

Answer

contain a cluster of nerve cell bodies (and their associated dendrites) of these afferent sensory
neurons

Answer

unipolar or pseudo-unipolar neurons

Answer

§ AFFERENT SENSORY PATHWAYS:
v Sensations are conducted from the periphery toward the SCord, first through a sensory spinal
nerve
v then they follow the DORSAL ROOT
v then the dorsal root divides into the DORSAL ROOTLETS
v THEN THEY TERMINATE IN THE POSTERIOR HORN OF THE GRAY MATTER IN THE SCORD

Answer

bilateral and symmetrical

Answer

Ventral (anterior)
§ VENTRAL ROOTLETS exit the spinal cord near anterior (ventral) horns, and transmit efferent nerve impulses (action potentials) away from the cord;
§ Ventral rootlets then converge into the VENTRAL ROOT (NO VENTRAL ROOT GANGLION)
v these nerve impulses consist of somatic motor impulses to skeletal muscles and
v autonomic (sympathetic and parasympathetic) impulses to smooth muscles, thoracic and abdominal organs, glands, etc.

Answer

EFFERENT SOMATIC MOTOR PATHWAYS:
*impulse comes from the brain down the SP
* Nerve cell body will be somewhere in the anterior horn
* the axon exits through the ventral rootlets to the ventral root
* joins to with the dorsal root ganglion to form the common spinal nerve
* terminates on skeletal muscle fibers

Answer

EFFERENT AUTONOMIC PATHWAYS:
v Nerve cell bodies are located in the lateral horn
v Autonomic nerve cell bodies will exit the same as Efferent somatic motor pathways
v Axon continues from that nerve cell body and then terminates on organs and tissues that have autonomic innervation

Answer

The common spinal nerve

Answer

Afferent is sensory while Efferent is motor or autonomic

Answer

-Dorsal horns of the gray matter;
-Laminae 1 =fast pain/acute pain(A-alpha)
-Laminae II and III (together are often referred to as the substantia gelatinosa): associated with Type C neurons and slow pain transmission
-Laminae III, IV, V, VI: primary neurons that are transmitting other sensations will terminate in one of these laminae of Rexed

Answer

Laminae VII – IX of ventral (anterior) horn contain cell bodies of efferent somatic motor neurons to skeletal muscles
- Lamina of Rexed VII is located in the LATERAL horn: AUTONOMIC PATHWAY

- the ventral horn is where nerve cell bodies for LOWER MOTOR NEURONS that exit the SCord and
transmit efferent somatic motor pathways to skeletal muscle fibers

Answer

v Neurons that are going to cross from one side of the SCord to the other are going to cross here at the lamina of Rexed X. A point of crossover(gray comminsure).
v Notice that the lamina of Rexed X is right around the central canal of the SCord

Answer

(aka, lamina marginalis)

Answer

the substantia gelatinosa

Answer

tract of Lissauer-specifically related to pain pathways

Answer

the meninges surrounding brain

Answer

o around the SCord, the dura mater is only one
single layer that DOES NOT ADHERE TO VERTEBRAE
o unlike the brain, the SCord dura mater has a
space between the DURA MATER and the
VERTEBRAL SPACE that is called the EPIDURAL SPACE

Answer

Underneath the dura mater is the subdural space: more of a potential space (than a real space) with thin film of fluid

Answer

Arachnoid mater;
o Has extensions of the arachnoid
o has lots and lots and lots of small, fragile vessels and CSF in the subarachnoid space

Answer

§ from the 3 foramina, from the 4th ventricle;
§ moves into the subarachnoid space around
the brain;
§ and the subarachnoid space around the brain
is continuous with the subarachnoid space around the SCord.
o Subarachnoid space: continuous with cranial
subarachnoid space; filled with cerebrospinal
fluid and weblike extensions of arachnoid
o Ends at level of S2 vertebra along with dura
mater

Answer

o Firmly attached to the SCord
o Thin vascular, connective tissue covering spinal
cord and nerve roots
o Below conus medullaris, pia mater continuous
with filum terminale, pierces dura mater and
arachnoid, and blends with connective tissue
behind coccyx
o On each side, pia mater attached to dura mater
by 22 denticulate (means tooth-like) ligaments, which anchor the cord
§ The denticulate ligaments: is where the pia mater extends outward and attaches to the dura mater
§ Extension of the pia mater, out through the arachnoid mater, that attaches to the dura mater.
§ That’s sort of a way of attaching the SCord, holding it in place, giving it a foundation

Answer

Nerve/vertebrae
C: 1 - C : 1
C: 2 - C: 2
C: 3 - C: 2-3
C: 4 - C: 3-4
C: 5 - C: 4-5
C: 6 - C: 5
C: 7 - C: 6
C: 8 - C: 6-7

Answer

Nerve/vertebrae
T: 1 - C: 7 – T: 1
T: 2 - T: 1-2
T: 3 - T: 2
T: 4 - T: 3
T: 5 - T: 3-4
T: 6 - T: 5
T: 7 - T: 6
T: 8 - T: 7
T: 9 - T: 8
T: 10 - T: 9
T: 11 - T: 10
T: 12 - T: 10-11

Answer

Nerve/vertebrae
L: 1 - T: 11-12
L: 2 - T: 11-12
L: 3 - T: 12
L: 4 - T: 12 – L: 1
L: 5 - T: 12 – L: 1

Answer

Nerve/vertebrae
S: 1 - L: 1
S: 2 - L: 1
S: 3 - L: 1
S: 4 - L: 1-2
S: 5 - L: 1-2
*(THESE 5 VERTEBRAE ARE FUSED IN ADULTS, BUT THE
FORAMINA ALLOW PASSAGE OF THE NERVES.)*

Answer

Coc: 1 - L: 1-2

Answer

Head, neck, shoulders, upper chest(arm pits up), and the upper extremities(arms, hands, fingers)

Answer

trunk(armpits down) and the posterior arms/forearms

Answer

anterior pelvis, anterior legs and tops of feet

Answer

genitals, posterior pelvis, legs, bottom of the feet

Answer

area right above the anus

Answer

somatic sensory

Answer

somatic motor
autonomic

Answer

C5, C6, C7, C8 and T1(with contributions from C4 and T2)

Answer

3
-superior
-middle
-inferior

Answer

6
-3 ventral
-3 dorsal

Answer

3
-lateral
-posterior
-medial

Answer

- musculocutaneous
-axillary
-radial
-median
-ulnar

Answer

([C4], C5, C6, C7)**

Answer

(C5, C6)**

Answer

(C5, C6, C7, C8, T1)**

Answer

([C5], C6, C7, C8, T1)**

Answer

([C7], C8, T1)**

Answer

O:POSTERIOR cord of brachial plexus(C5-C6)
INNERVATION: Inferior lateral shoulder(deltoid)

Answer

O:Posterior cord of brachial plexus(C5-T1)
INNERVATION: Posterior surface of arm and forearm, lateral 2/3 of dorsum of the hand(triceps)

Answer

O:Lateral cord of brachial plexus(C5-C7[C4])
INNERVATION: Lateral surface of forearm(biceps)

Answer

O:Medial cord of brachial plexus(C8-T1[C7])
INNERVATION: Medial third of hand, little finger and medial half of ring finger

Answer

O:Medial and lateral cords of brachial plexus(C5-T1)
INNERVATION: Lateral 2/3 of palm of hand, thumb, index and middle fingers, and the lateral 1/2 of ring finger and dorsal tips of the same fingers(PALMER AND DORSAL SURFACE)

Answer

-head movement
-diaphragm movement
-neck and shoulder movement
-some upper limb movement

Answer

-some upper limb movement
-rib movement in breathing, vertebral column movement and tone in postural back muscles
-also some hip movement

Answer

-hip movement
-some lower limb movement

Answer

-lower limb movement

Answer

o THE RIGHT AND LEFT VERTEBRAL ARTERIES
o So if there is decreased blood flow through the
vertebral arteries, that’s going to affect blood flow
through both anterior and posterior spinal arteries.

Answer

ANTERIOR SPINAL ARTERY

Answer

Left and Right posterior spinal arteries

Answer

Left intercostal artery

Answer

LEFT AND RIGHT POSTERIOR SPINAL ARTERIES

Answer

Outer zone: is supplied mainly by the penetrating pial plexuses

PENETRATING BRANCHES OF PIAL PLEXUS SUPPLY outer part of substance of spinal cord, including:
o Posterior horns (posterior gray matter)
o Anterior horns (anterior gray matter)

Answer

Middle zone: is supplied by both central and penetrating pial plexuses

Answer

Inner zone: is supplied mainly by the central pial plexuses

*central canal*

Answer

no blood flow through the artery of ADAMKIEWICZ

Answer

motor deficits

Answer

1 anterior spinal artery
2 posterior spinal artery

Answer

Radicular arteries have their origin somewhere outside the vertebral column
Pass through intervertebral foramina, along with nerve
roots, the arteries that reach the SC make contributions to the anterior spinal artery

Answer

Artery of Adamkiewicz

Answer

Left Intercostal Artery

Answer

yup; Anastomotic loop from both the anterior and posterior arteries.

Answer

Arise from anterior and posterior spinal arteries and interconnect on surface of spinal cord to form pial
plexus

Answer

1. SKIN – POSTERIOR SURFACE OF BODY
2. SUBCUTANEOUS TISSUE
3. SUPRASPINAL LIGAMENT
4. INTERSPINAL LIGAMENT
5. GAP BETWEEN LEFT AND RIGHT
LIGAMENTA FLAVA
6. EPIDURAL SPACE
7. DURA MATER
8. SUBDURAL SPACE
9. ARACHNOID MATER
10. SUBARACHNOID SPACE/CEREBROSPINAL
FLUID
11. POSTERIOR (DORSAL) MEDIAN SULCUS
12. PIA MATER
13. POSTERIOR (DORSAL) COLUMN WHITE
MATTER
14. POSTERIOR GRAY COMMISSURE
15. CENTRAL CANAL OF SPINAL CORD
16. ANTERIOR GRAY COMMISSURE
17. ANTERIOR WHITE COMMISSURE
18. PIA MATER
19. ANTERIOR (VENTRAL) MEDIAN FISSURE
20. ANTERIOR SPINAL ARTERY
21. SUBARACHNOID SPACE
22. ARACHNOID MATER
23. SUBDURAL SPACE
24. DURA MATER
25. EPIDURAL SPACE
26. POSTERIOR LONGITUDINAL LIGAMENT
27. ANULUS FIBROSUS
28. NUCLEUS PULPOSUS
29. ANULUS FIBROSUS
30. ANTERIOR LONGITUDINAL LIGAMENT

Answer

Gray commissure surrounds the central canal
o Located in the gray commissure = axons passing from on side of the SCord to the other side

Answer

Anterior white commissure: is also where axons pass from on side of the SCord to the other side
o There is no POSTERIOR white commissure; the posterior median sulcus comes all the way in to the
gray matter

Answer

Afferent sensory pathways
o come from the periphery and pass through the common spinal nerve
o the common spinal nerve divides
o and then travels through the dorsal root ganglia
§ dorsal root ganglion is the location of the nerve cell
bodies of those primary sensory neurons
o then the dorsal root
o then the dorsal rootlets
o into the dorsal horn of the gray matter of the SCord

Answer

Somatic motor and autonomic pathways
o Somatic motor neurons exit from the ventral horn of the gray matter
o into the ventral rootlets
o then the ventral root
o then enters the common spinal nerve
o then terminates in the skeletal muscle fibers to bring about a response

Answer

Pathways: is from the periphery all the way to the brain
o Starts in the periphery, goes to the SCord, up the SCord and terminates in the brain

Answer

Tracts: is the part of the pathway that is in the white matter in the SCord
o The part of the pathway that is in the white matter of the SCord is TRACTS

Answer

1. Fasciculus gracilis
2. Fasciculus cuneatus

Answer

Spinothalamic-important role in the transmission of pain

Answer

3; primary, secondary, tertiary

Answer

peripheral

Answer

free nerve endings

Answer

pain, temperature, light touch, pressure, tickle and itch

Answer

cutaneous receptors

Answer

Cerebral cortex-post central gyrus

The axon again ascends from the thalamus, to
the primary sensory cortex, the post central gyrus and it terminates according to the layout of the sensory homunculus

Answer

Dorsal root ganglion

Answer

It is located in the POSTERIOR horn of the
SCord

Answer

• The nerve cell body of the TERTIARY neuron
is in the THALAMUS
-Up through the medulla, pons, and midbrain
and terminates in a specific nucleus of the
thalamus
• ALL SENSATIONS USUALLY END UP IN
THE THALAMUS before their transmitted to
other parts of the brain

Answer

enters at the posterior white commissure(Laminae 1 if fast pain) and crossover at anterior white/anterior gray commissure

Answer

same side of the body(ipsilateral)

Answer

contralateral

Answer

unipolar or pseudo-unipolar

Answer

Glutamate; type A delta

Answer

-Initially glutamate followed by Substance P.A.
-Type C unmyelinated.

Answer

the axon of the secondary neuron immediately crosses over through the anterior white/ anterior gray commissure; opposite side of the SCord.
• The point of crossover is in the same segment of the SCord where the primary neuron entered
• Primary neuron enters in through a certain segment of the SCord
• Terminates/ synapses with the secondary neuron
Immediately the axon of the secondary neuron crosses over, through the anterior white or anterior gray commissure, to the opposite side of the SCord
• And enters into the SPINOTHALAMIC
TRACT

Answer

The same side where the interrupted transmissions is

Answer

Contralateral or the opposite side

Answer

Contralateral

Answer

Just the dermatomes that are innervated for that peripheral nerve

Answer

Below the level where the interrupted transmission has occurred
o So if interrupted transmission is in the lumbar segment of the SCord, it would involve the hips, legs and feet of the opposite side.
o If interrupted transmission is in the thoracic segment of the SCord, then all the body below where the interrupted transmission will experience a loss of those sensations

Answer

1. Fasiciculus cuneatus
2. Fasciculus gracilis

Answer

From the neck, thorax, nipple line, arms, hands and fingers

Answer

From the nipple line to lower part of the body

Answer

-Proprioception, PRIMARILY CONSCIOUS PROPRIOCEPTION
-Two point discrimination (fewer receptors on back as opposed to arms/ hands)
-Pressure (deep)
-Vibratory sensations

Answer

Fasiciculus gracilis

Answer

Both because the gracilis still has to travel up the SC to brain

Answer

PACINIAN CORPUSCLE
§ those are sensory receptors that are modified nerve endings to respond to the types of sensations are listed ABOVE

Answer

Dorsal root ganglion

Answer

the primary neuron

Answer

A. IN THE MEDULLA
o Ascends on the same side of the SCord and terminates in either the nucleus cuneatas/ gracilis
o Synapses with the nerve cell body of the secondary neuron
o Now the axons crossover to the opposite side of the medulla
o Ascend in what is called the medial lemniscus, up to the thalamus
o Then tertiary neuron, then primary sensory cortex

Answer

Beginning of the primary neuron; notice that the sensory receptor is the PACINIAN CORPUSCLE
• Nerve cell body there in the dorsal root
ganglion
• The axon enters into the dorsal horn of the
gray matter of the SCord
• NOW watch carefully; as soon as the axon of
the primary neuron, enters into the dorsal horn
of the gray matter of the SCord
• It continues from the gray matter into the
dorsal column white matter
• Enters into the fasiciculus cuneatas (or
gracilis) [picture shows gracilis]
• Ascends up the SCord to the medulla where it
terminates to the NUCLEUS cuneatas or
gracilis
• Axons from the primary neuron, enter into the fasiciculus cuneatas or gracilis
• Axons of the primary neuron form the
ascending tract and IT HAS NOT YET CROSSED OVER
• Continues up the SCord on the same side it entered up to the medulla
• Once we get to the medulla, were the primary neuron terminates; the nucleus cuneatas/ gracilis synapses
with the nerve cell body of the secondary neuron
• The axon of the secondary neuron crosses over to the opposite side of the medulla
• Enters into the MEDIAL LEMNISCUS
• Ascends up through the pons, midbrain and terminates in a specific nucleus of the thalamus Synapses with the nerve cell body of the tertiary neuron and that axons continues from the thalamus to the
primary sensory cortex according to the layout of the sensory homunculus

Answer

-Ipsilateral
-The dermatomes that are innervated by that peripheral nerve

Answer

-Ipsilateral. The pathway has not yet crossed over.
-Below the SCord segment where the transmission is interrupted

Answer

-contralateral
-All of it because it has input from FC and FG.

Answer

I want to impress upon you, the importance of:
o what forms the ascending tract?
o which side of the SCord does the tract ascend on?
o and where is the point of crossover?
§ if interrupted transmission is BEFORE the crossover, the loss is on the SAME side of the body as interrupted transmission
§ if interrupted transmission is AFTER the crossover, the loss is on the OPPOSITE side of the body

Answer

These are going to transmit primary proprioceptive information to the cerebellar hemispheres
o And this is for the most part UNconscious
proprioception (almost all)

Answer

joints, tendons

The beginning point of the primary neuron is
the GOLGI TENDON ORGANS
o Golgi tendon organs are part of the
skeletal muscles system
o Actually outside of the skeletal muscle
fiber
o As the tension on the skeletal muscle
changes, the tension on the golgi tendon
organ changes also
o This is detecting changes in muscle
tension; allowing it to transmit proprioceptive information

Answer

The primary neuron, the nerve cell body is
located in the dorsal root ganglion

Answer

Enters into the dorsal horn of the gray matter
of the SCord where it terminates
• Synapses with the nerve cell body of the
SECONDARY neuron
• The axon of the secondary neuron immediately continues out into the posterior column white matter, on the same side
• Ascends in the posterior spinocerebellar tract
• Then terminates in the cerebellar hemisphere
• ALL OF THAT IS ON THE SAME SIDE
• NO CROSSOVER IN POSTERIOR
SPINOCEREBELLAR

Answer

So through posterior spinocerebellar,
proprioceptive information from the RIGHT
side of the body ends up in the RIGHT
cerebellar hemisphere and the LEFT to LEFT
• POSTERIOR SPINOCEREBELLAR IS GENERALLY
BELIEVED TO BE THE MORE IMPORTANT OF THE TWO
IN HUMANS

Answer

• Little different than POSTERIOR
• It does transmit proprioceptive information
• Primary neurons begin with golgi tendon organs
• Enters into the dorsal horn of the gray matter of the SCord where it terminates
• Synapses with the nerve cell body of the secondary neuron
• THE AXON OF THE SECONDARY NEURON CROSSES OVER, ANTERIOR WHITE/ ANTERIOR GRAY COMMISSURE TO THE OPPOSITE
SIDE OF THE SCORD
• Enters into the ANTERIOR spinocerebellar tract where ascends to the medulla
• AND CROSSES OVER AGAIN AND ENDS UP IN THE CEREBELLAR HEMISPHERE OF THE SAME SIDE WHERE IT STARTED

Answer

-Posterior never crosses over
-Anterior crosses over and then crosses back over again ending up back on the same side where it started

Answer

Descending Somatic Motor also the Pyramidal Pathway

Answer

The Corticospinal enter into the pyramids of the anterior/
inferior medulla

Answer

Responsible for MOST muscle movements
• Particularly muscle movement of our hands and fingers
• In the descending somatic motor pathways there are TWO neurons in sequence
• Designated an upper motor neuron and lower motor neuron
• Since they are descending somatic motor pathways, the point of origin will be in the primary motor cortex
• Descend downward and outward out of the SCord to skeletal muscle fibers

Answer

about 75-80% of those axons DECUSSATE
• They cross over to the OPPOSITE SIDE of the SCord and
descend in the LATERAL corticospinal tract

Answer

The other 20-25% that do not crossover at that point, remain on the SAME SIDE of the SCord and descend in the ANTERIOR corticospinal tract

Answer

-The axon that are going to form the lateral corticospinal
tract and the decussation of the pyramids; the axons
crossover to the opposite side; enter into and descend in
the lateral corticospinal tract
-The 20-25% that do not decussate at that point continue descending on the same side of the spinal cord in the anterior corticospinal tract

Answer

terminate, synapse

Answer

in the anterior (ventral) horns of the gray matter of the SCord

Those axon exits through ventral rootlets, then ventral roots
• Enter into a common spinal nerve
• Terminate at the neuromuscular junction; to bring about a response in a skeletal muscle fiber

Answer

For the ANTERIOR corticospinal tract; the upper motor neurons terminate and synapse with lower motor
neurons, then crossover in the SCord segment where they synapse with the lower motor neurons.

Answer

• In humans, the far more important is the lateral corticospinal tract
• Particularly the skeletal muscle movement of the arms, hand and fingers

Answer

-Contralateral; The pathway has not yet crossed over
-Basically all of it

Answer

-Ipsilateral
-Below the level where the interrupted transmission occurs

Answer

-Ipsilateral
-Just the muscles innervated by that lower motor neuron.

Answer

-Contralateral: has not yet crossed over
-Below the level where the interrupted transmission occurs

Answer

Ipsilateral; And just the muscles that are innervated by that lower motor neuron

Answer

Responsible for UNconscious coordination of skeletal muscle movement and maintaining posture and balance

Answer

People who have extrapyramidal alterations in one or more pathways, usually have very poor posture; can’t stand up straight, tend to sway (because they do not know where their body parts are in time or space)
• They have unsteady and awkward gait
• Likely to fall on face if Romberg test is performed
• Uncontrollable muscle movements, such as: ticks of their face, head and other parts
• Lip smacking is very common with people who have
advanced extrapyramidal pathway alterations • Tongue rollin

Answer

People who had advanced mental disorders like
schizophrenia who were on high-dose antipsychotics
like Compazine, Thorazine, Phenergan, and others
like that.
o They were the first group of antipsychotics that were
available to pharmalogically control those severe
mental illnesses.
o And with very high doses, they had very severe
extrapyramidal side effects.

Answer

CORTICOBULBAR PATHWAYS

Answer

Upper motor neurons originate in cerebral motor cortex according to layout of motor homunculus
• The upper motor neurons of most, but not all, motor pathways originate in both left and right primary motor
cortices of the cerebral hemispheres. Thus these pathways contain crossed and uncrossed fibers.
o So, the motor pathways to the right side of the face and head originate in both the right and left cerebral
cortices and the motor pathways to the left side of the face and head originate in both the right and left
cerebral cortices.

Answer

Lower motor neurons are cranial nerves with a motor component
o CN: III, IV, V, VI, VII, IX, X, XI, XII

Answer

On(Olfactory)
Old(Optic)
Olympus(Oculomotor)
Tower(Trochlear)
Tops(Trigeminal)
A(Abducens)
Fin(Facial)
And(Auditory/Acoustic/Vestibulocochlear)
German(Glossopharyngeal)
Viewed(Vagus)
Some(Spinal Accessory)
Hops(Hypoglossal)

Answer

CN#1-Some(sensory)
CN#2-Say(sensory)
CN#3-Marry(motor)
CN#4-Money(motor)
CN#5-But(both)
CN#6-My(motor)
CN#7-Brother(both)
CN#8-Says(sensory)
CN#9-Big(both)
CN#10-Brains(both)
CN#11-Matter(motor)
CN#12-Most(motor)

Answer

Any CN that has motor fibers will also have proprioceptive sensory fibers
o So if there is motor innervation of the muscle, there has to be proprioceptive sensory feedback from the muscle group
o III, IV, V, VI, VII, IX, X, XI, XII

Answer

Some also have parasympathetic fibers
-III, XII, IX, X … 3,7,9,10 … 3,7,9,10 … 3,7,9,10 …

Answer

CN X: IS THE PRIMARY PARASYMPATHETIC NERVE FOR THE ENTIRE BODY
o Descends down through the side of the neck
o down through the thorax
o pierces the diaphragm
o continues on down through the abdominal cavity and gives off collaterals to every major organ and
tissue all the way down
o DOES NOT innervate:
§ sigmoid colon
§ descending colon
§ anus
§ genitals

Answer

• MEDULLA: CN IX, X, XI, XII
o CN IX, X:
§ sensory nucleus: nucleus solitarius (those who are too SENSitive may find themselves living in SOLITude)
§ motor nucleus: nucleus ambiguus (on SNL, the AMBIGUously gay duo were always riding around in an “oddly” shaped MOTOR vehicle)
• PONS: CN V, VI, VII, VIII
• MIDBRAIN: CN III, IV
• I cannot tell you where nerve cell bodies for CN I
& II are; they form very different pathways then
CN III – XII

Answer

Sensory pathways have 3 neurons in sequence similar to spinal sensory pathways:
o PRIMARY neuron with sensory receptors
§ The primary neuron is usually, but not always, the peripheral nerve (has not yet entered the brain)
component of the pathway
o SEONDARY neuron that usually, but not always, crosses (decussates) to opposite side of brain and
terminates in a thalamic nucleus
o TERTIARY neuron that terminates in sensory areas of the cerebral cortex for sensory perception/
interpretation and isolation to dermatomes
o CN I and II deviate from the general pattern of CN sensory pathways

Answer

• Sensory fibers only
• function to smell
• transmit olfactory sensations to many parts
of the brain
• that’s all I am going to
say about that

Answer

-You do need to remember that CN III is responsible
for MOST extra ocular movements (EOM)
-Most of the muscles that causes those movements are innervated by the CN III (oculomotor); however there are 2 other cranial nerves:
* CN IV – innervates one of those muscles
* CN VI – innervates one of those muscles
-Not only do those nerve pathways have to be intact
• the neuromuscular synapse has to be intact
• the muscles themselves have to be able to contract

Answer

-up and out
-up and in
-down and out

Answer

-down and in

Answer

-laterally

Answer

• I want you to primarily associate trigeminal with:
MOST of the sensations from the face and head
are transmitted through the trigeminal n.
• One branch of the trigeminal has SOME
motor function; primarily those muscles involved
with chewing

Answer

o V1: Ophthalamic: transmits sensations from the upper eyelid, most anterior part of the nose, and from the
cornea (reflex)
o V2: Maxillary: transmits sensations from the lateral side
of the head, lower eyelids, lateral side of the nose (not the sense of smell), and upper lip
o V3: Mandibular: transmits sensations from the lower lip, chin, and the mandibular branch has some motor fibers that innervate the muscles for chewing (mastication).

Answer

• I want you to associate FACIAL: most facial
expressions, are caused my muscles innervated by the
facial CN
• It also has some sensory fibers
o for the most part taste
• And has some
parasympathetic function
• If both of the CNs are functioning; raise your
eyebrows, both should be raised at the same height
• If you were to frown or puff out your cheeks, it
should both be symmetrical.
o If there is asymmetry, there is weakness on the
affected side.

Answer

• Transmits hearing from the inner ear to the primary
auditory center located in the temporal lobe.

Answer

• It has all 4 types of fibers
• The motor is primarily to some of the muscles of the
PHARYNX
• Proprioception sensation from those muscles
• Motor also has to do with; when you phonate
“ummm”, your uvula should rise in the midline
o If there is an abnormality to one side
or the other of the nerve, then the uvula will deviate from the midline; to the L or R
o Another test is the gag reflex (you have to actually touch the back of the throat)
• Sensory primarily has to do with taste
• Associated with the nucleus solitarius and ambiguus

Answer

• Has all 4 types of fibers
• It also associated with nucleus solitarius and
ambiguus
• Most of the motor is to pharynx (the muscles of
phonation)
• And of course proprioception
• Sensation: the pharynx and larynx
• Sensations for most abdominal organs are
transmitted through sensory fibers through the
vagus
o There is no area on the sensory homunculus for the internal organs
o So when sensations are transmitted to the vagus from those organs, when it gets to the SCord and then the brain; it perceives those sensations as if they originated from the surface of the body; this is called REFERRED PAIN

Answer

• Probably is not a CN at
all
• For many people the origin is in the upper part
of the SCord, not in the lower part of the medulla
• So if its origin is really part of the SCord, it
should be a spinal nerve, not a CN
• Motor and proprioception for the muscles of the shoulder; primarily the muscles for turning the head or shrugging the shoulders

Answer

• Most of the muscle involved in the movement
of the tongue and some of the muscles in the throat
• Tongue should protrude in the midline
• If it deviates to one side or the other, that may
suggest an abnormality of CN XII; it points to the
side where the altered transmission is at

Answer

A. The lateral ventricle of the brain

Answer

corpora quadrigemina (located in the midbrain)
v Associated with visual reflexes.

Answer

Lateral don't cross; medial cross in the optic chasm

Question 2

2

How many vertebra in the cervical region of the spinal column?

7

Question 3

3

How many vertebra in the thoracic region of the spinal column?

12

Question 4

4

How many vertebra in the lumbar region of the spinal column?

5

Question 5

5

How many vertebra in the sacral region of the spinal column?

5

Question 6

6

How many vertebra in the coccygeal region of the spinal column?

4

Question 7

7

Is the word vertebrae plural or singular?

Question 8

8

How many curvatures of the spine is seen normally and describe each curvature.

Question 9

9

What is the purpose of the body of the vertebra?

Question 10

10

What makes up the vertebral arch of the vertebra, and where does it attach in relation to the other structures of the spinal column?

Question 11

11

Describe the traverse process of the spinal column.

Question 12

12

Describe the spinous process of the spinal column.

Question 13

13

What is the purpose of the vertebral foramen?

Question 14

14

Describe the intervertebral foramina(notch).

Question 15

15

What is the pedicle of the spinal column?

Question 16

16

What is the lamina of the spinal column?

Question 17

17

What is the function of the articular processes of the spinal column?

Question 18

18

What is different about C1(atlas) from the rest of the cervical region of the spinal column?

Question 19

19

What is different about C2(axis) from the rest of the cervical region of the spinal column?

Question 20

20

What is a bifid spinous process of the spinal vertebra?

Question 21

21

What are the characteristics of the cervical region of the spinal column?

Question 22

22

What is special about C7?

Question 23

23

What are the characteristics of the thoracic region of the spinal column?

Question 24

24

What are the characteristics of the relationship between the thoracic column and the rib articulations?

Question 25

25

What is the significance of the "sternal angle"?

Question 26

26

What are the characteristics of the lumbar region of the spinal column?

Question 27

27

What are the characteristics of the sacral region of the spinal column?

Question 28

28

What are the characteristics of the coccyx region of the spinal column?

Question 29

29

What is the purpose of the intervertebral disks of the spinal column?

Question 30

30

What are the two parts of the intervertebral disk and their function?

Question 31

31

Why is it important that the disk remain a consistent size?

Question 32

32

What are herniated disc?

Question 33

33

Where does the Anterior Longitudinal Ligament extend from, towards what and what does it connect?

Question 34

34

Where does the Posterior Longitudinal Ligament extend from, towards what and what does it connect?

Question 35

35

What is the function of the Ligamenta Flava

Question 36

36

Where does the Supraspinal Ligaments extend from and to, and what are their function?

Question 37

37

Where does the Interspinal Ligaments extend from and to, and where are they best developed?

Question 38

38

What do the Inter-transverse Ligaments adjoin, and where do they extend from and to?

Question 39

39

What separates the inferior medulla oblongata from the superior SC?

Question 40

40

How long is the spinal cord? Where does the spinal cord terminate?

Question 41

41

What are the two enlargements of the spinal cord?

Question 42

42

At what structure does the SC terminate(L1,L2)?

Question 43

43

Whats the name of the ligament that anchors the spinal cord to the coccyx?

Question 44

44

What nerves supply the upper limbs?

C4-T2

Question 45

45

What nerves supply the lower limbs?

L3-S3

Question 46

46

How many total pairs of nerves are there?

31

Question 47

47

How many cervical nerves?

8

Question 48

48

How many thoracic nerves?

12

Question 49

49

How many lumbar nerves?

5

Question 50

50

How many sacral nerves?

5

Question 51

51

How many coccygeal nerves?

1

Question 52

52

How are the nerve rootlets named?

Question 53

53

What is the name of the group of rootlets that extend below the level of the SC and terminating at the Filum terminale called?

Question 54

54

Where does the first cervical nerve exit the spinal column?

Question 55

55

What nerves make up the Brachial plexus?

Question 56

56

What does the gray matter of the spinal cord consist of(2) and what happens there?

Question 57

57

The gray matter is divided into what two sections?

Question 58

58

Only those segments of the SC associated with the autonomic nervous system have _ _ in the gray matter of the SC.

Question 59

59

What is located in the central canal of the SC?

CSF

Question 60

60

What is the area within the gray matter called where it crosses from one side of the SC to the other?

Question 61

61

The central canal communicates with what structure at its most superior point?

Question 62

62

What does the white matter consist of(2)?

Question 63

63

What separates the right and left sides of the SC on the posterior side?

Question 64

64

Who Is It For?